Dear Doctors Column October 29, 2007
Antibiotics No Longer Recommended Before Routine Dental Appointments
Question:
I have mitral valve prolapse and have always been cautioned to take antibiotics before having any kind of dental work done. Now I hear this is no longer necessary. Is it safe for me to give up my precautionary antibiotics? Answer:
In April 2007 the American Heart Association (AHA) reversed its longstanding recommendation that people with certain heart abnormalities, including those who have mitral valve prolapse, rheumatic heart disease, or people born with problems with the heart’s structure, take antibiotics before all dental procedures. People with such abnormalities have a higher risk of infective endocarditis, a potentially life-threatening infection of the heart’s valves or inner lining.
People with heart conditions ranging from mild mitral valve prolapse to serious cardiac birth defects have been told for more than 50 years that taking antibiotics before any dental procedure reduces the likelihood of this serious infection.
In a recent years, however, there has been a growing body of scientific evidence that shows taking antibiotics before dental procedures does not prevent infection and may even cause harm. It’s this evidence, which is based on studies conducted in the 1990s, that prompted the AHA to radically revise its guidelines. The organization now recommends that only people with the highest risk of infection take preventive antibiotics prior to routine dental work. This high-risk group includes people with:
Ø artificial heart valves;
Ø previous infective endocarditis;
Ø certain, specific birth defects of the heart;
Ø a birth defect of the heart that has been repaired with artificial material or with a device in the last 6 months;
Ø a problem with a heart valve that develops after heart transplantation.
According to the new recommendations people who were once routinely given preventive antibiotics before dental visits but who no longer need take them are those with:
Ø mitral valve disease;
Ø aortic valve disease;
Ø calcified aortic stenosis;
Ø rheumatic heart disease;
Ø structural disorders such as atrial or septal defect or hypertrophic cardiomyopathy.
Because cardiac conditions can be very complex, authors of the new guidelines recommend that people who have heart abnormalities check with their cardiologists to make sure they don’t fall into the high-risk group that still needs preventive antibiotics.
It may be tempting for some people outside this risk group to follow a better-safe-than-sorry approach and continue taking antibiotics before routine dental work, but there are problems with the drugs beyond the lack of evidence showing they protect people from infection. Antibiotics can cause uncomfortable and serious side effects. In addition, overuse of antibiotics is causing infectious organisms to mutate and develop drug resistance. Antibiotic-resistance is a growing problem in the United States and around the world, where bacteria that doctors could once easily treat with routine antibiotics are turning into organisms that cannot be overcome with commonly available drugs.
You can get infections from simply chewing food and brushing your teeth, and UAB dental experts note that good oral hygiene is probably the best way to prevent problems.
The bottom line: if you’ve been taking antibiotics before every dental visit, check with your dentist (and your cardiologist if you have any questions about your heart condition) to see if you can skip these potentially harmful drugs.